How a Zambian morgue is exposing the real covid toll in Africa

By measuring deaths but not background infection rates, the study does not attempt to calculate the chance that a Lusaka resident with SARS-CoV-2 will develop a serious infection or die. (A WHO meta-analysis of antibody studies from 14 African countries, which has not yet been peer-reviewed, estimates that two-thirds of cases on the continent have been asymptomatic.)

Still, as a rare attempt to investigate Africa’s death toll with clinical data, the BU team’s work has had a significant impact, outside experts say. Before his first paper, says Watson, who worked on a number of Covid-19-related studies in low-income settings, there was a “pretty even balance” within academia between those who believed that “something fundamentally different in Africa meant no there was so much death going on” and those who emphasized the lack of data.

The Zambia study, he says, played a major role in “shifting the narrative” towards the latter idea. Kirenga, from Uganda, says the study resonates with his observations about the likelihood of undercounting there. But Roma Chilengi, special covid-19 adviser to Zambian President Hakainde Hichilema, who also heads the organization that compiles Zambia’s official surveillance data, says he still believes the pandemic has not been as deadly in his country as it is believed. expected: initial fears that it would “sweep like wildfire”, he told me, have not come to pass. Still, Chilengi broadly agrees with the BU team’s conclusions. “As an exploratory observation, there is no question that we had a lot of people who died of covid but were not diagnosed,” she says.

Survivors and algorithms match

Beyond the UTH cadavers, a growing body of non-clinical studies has also added weight to the claim that most of Africa’s deaths have been missed. An article published in The Lancet last May, which tracked nearly 6,800 confirmed or suspected covid-19 patients referred to intensive care centers in 10 African countries, found that less than half were admitted and 48% of those who died. in a month. According to the paper’s authors, this represents an excess hospital mortality of 11 to 23 deaths per 100 patients compared to the global average, a figure they link to understaffing and the frequent absence of life-saving interventions, such as oxygenation and dialysis.

Baron Nkonde in the hospital laboratory


Although Zambia was not included in the study, locals told me that the gaps in treatment were also acute. Sky Banda, a 58-year-old resident of Kaunda Square, a compound named after Zambia’s first president, says many members of the community who fell ill during the height of the pandemic saw hospital admission as a “ticket straight to the morgue.” Most opted for herbal treatments at home instead.

Onechi Lwenje, a 36-year-old filmmaker who spent a week in the covid-19 ward at UTH during Zambia’s second wave in early 2021, says staff were so overwhelmed some patients died and went undetected for hours. “Most of the people who went into that room never came out,” he says.

Although Africa’s death records remain patchy, attempts to approximate excess mortality through statistical solutions also support the theory of substantial undercounting. A machine learning model developed by The Economist, based on more than 100 indicators that correlate with excess deaths in countries where such data is available, suggests that Africa has seen between 1.1 million and 3 million excess deaths since the beginning of the pandemic. A model from the Institute for Health Metrics and Evaluation at the University of Washington, included in an article published by The Lancet in March, puts the figure, as of December 2021, at 2.1 million for sub-Saharan Africa alone, with a central estimate for Zambia. of 81,000, 20 times the official toll of 3,967.

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